The poor structure of the Act establishing Nigeria’s Health Insurance Scheme (NHIS) is the major cause of various crises that have trailed the scheme over the years, the Minister of Health, Isaac Adewole, has said.

The minister also linked the inability of the scheme to cover majority of Nigerians, more than a decade after its establishment, to loopholes in Act. He insisted the Act should have made health insurance compulsory for all Nigerians.

“The Act made insurance voluntary and that is why we are supporting National Assembly to repel the Act and put in place a comprehensive package. Let it be comprehensive because it cannot be voluntary. There is need for review of the Act and it is (ongoing)”, Mr Adewole, a professor, said during an exclusive interview with PREMIUM TIMES.

“I can tell you today that no Executive Secretary of NHIS has completed a full term in office without being sacked or suspended, apart from Mohammed Dogo, the pioneer ES, so it’s not just about this administration.

“Social media has made information readily accessible and available. It made things look as if it is only now that these things are happening, it used to happen before. We are asking the presidential panel to take a more holistic look at the NHIS, to review the Act of the scheme. The Act seems to have given so much power to the governing board,” Mr Adewole noted.

The NHIS has been a cesspool of fraud, corruption and controversies even before the current embattled Executive Secretary of the scheme, Usman Yusuf took over.

Nigeria’s president, Muhammadu Buhari, had in July 2016, appointed Mr Yusuf, to quell the storm in the scheme but his reign stoked even more crises, which has further heated the tension at the agency.

Mr Yusuf, a professor of Haematology-Oncology and Bone Marrow Transplant, was last October, sent on an indefinite suspension by the governing board over allegations of fraud and infractions.

It was his second over similar allegations since he assumed office.

Rather than obey the sanction, Mr Yusuf stormed the NHIS head office with a contingent of about 50 police officers, broke a barricade mounted by angry workers and forced his way into his office. He maintained that the governing council had no powers to sanction him.

Activities remained grounded at the agency, with workers and management pitched against each other until Mr Buhari ordered the controversial official to proceed on an ‘administrative leave’.

The president deployed Ben Omogo, a Director of Administration in the Office of the Head of the Civil Service of the Federation, to “oversee the affairs of the Scheme”, temporarily.

The Act governing the NHIS is not very clear on the issue of suspension of the Executive Secretary.

The word, “suspension”, does not appear anywhere in its laws, much less in relation to the head of the agency.

Meanwhile, the Part 3 section 8 (3) of the Act states that the Executive Secretary is “subject to the general direction of the Council.”

Perhaps, this is the part that the council has latched on to draw the power to suspend the executive secretary.

“The governing council, by that Act, was given the power to do whatever is necessary to keep the scheme running. If the council now thinks it is important to do anything to keep the scheme running, nobody can say no,” Mr Adewole highlighted, during the interview.

“That is why we say the Act needs to be revised and be more specific. If you look closely, it is as if the council does almost everything there. The Act is one of the major issues with the scheme. Why NHIS has not covered majority of Nigerians, is because it is voluntary.”

“When it is voluntary, it makes people not take it seriously. Our disposition- as Nigerians, (is that) we don’t take our health critical. We don’t even treat our body the way we treat our car. When we wake up in the morning, you have a car you clean it up, you test the engine oil, you test the water level etc. Many people don’t treat their body as well as they treat their cars.

“When it comes to health, nobody wants to pay for health. We all want it free and that is why, for us to make it free, somebody has to pay for it. In the UK, the health insurance is there but it’s being funded, essentially, by taxation. What we need to look at in NHIS is – how do we put more money in health, put more resources together, to take care of every body and ensure maximum coverage?”

While millions of Nigerians remain uncovered, the few enrolled under the scheme are complaining of inadequate service delivery.

Since its establishment 13 years ago, a majority of Nigerians are yet to be covered under the scheme. Mr Yusuf said last year that over 90 per cent of Nigerians are not captured under the NHIS.

Many have traced the relative poor coverage to the structure of the scheme, which has been tainted with financial irregularities gone unchecked.

The governing board of NHIS, last October, raised an alarm that the agency is near a “tipping point” and may collapse within the next three years, unless urgent measures are taken.

With a new Act, practitioners in the health sector believe a more efficient way the scheme should function, will be clearly stated.